We require your consent to collect personal information about you. Please read this information carefully and sign where indicated below.
The Mind + Gut Specialist Clinic collects information from you for the primary purpose of providing quality health care. We will use the information you provide in the following ways:
- Administrative purposes in running our clinic
- Billing purposes including Medicare and Health Insurance Commission requirements
- Retrieving medical history from other health providers
- Disclosure to others involved in your health care including doctors and specialists outside this clinic. If you do not wish for contact to be made with others involved in your health care, please tick here:
I have read the information above and understand the reasons why information must be collected. I am also aware that the clinic follows guidelines to protect patient privacy in compliance with privacy legislation.
I consent to the handling of my information by this practice for the purposes set out above.